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Does improved oral hygiene alone prevent ventilator-associated pneumonia?

Introduction

Up to 20% of patients receiving mechanical ventilation for >48 hours will develop ventilator-associated pneumonia (VAP) [1]. Dental plaque and oropharyngeal (OP) secretions of intubated patients often contain organisms capable of causing VAP [2].

Methods

An intervention to improve oral hygiene (8-hourly OP cleaning/suctioning, toothbrushing and instillation of chlorhexidine gel) was commenced in one zone of an adult general ICU. Nursing staff in the rest of the ICU delivered standard oral hygiene (concurrent control). No other specific VAP prevention strategies were used in any patient. All patients on mechanical ventilation were reviewed daily for VAP using National Nosocomial Infections Surveillance criteria [3].

Results

In a 4-month period, 71 patients were admitted to the intervention zone (Group A) and 189 patients were admitted to control beds (Group B). Table 1 summarises the results with values for age, APACHE II score and length of ICU stay shown as medians and interquartile ranges.

Table 1 (abstract P292)

Conclusion

Use of an intervention to improve oral hygiene was associated with a reduction in the incidence of VAP.

References

  1. 1.

    Safdar N, et al.: Clinical and economic consequences of ventilator associated pneumonia: a systematic review. Crit Care Med 2005, 33: 2184-2193. 10.1097/01.CCM.0000181731.53912.D9

  2. 2.

    Fourrier F, et al.: Colonisation of dental plaque: a source of nosocomial infections in intensive care unit patients. Crit Care Med 1998, 26: 301-308. 10.1097/00003246-199802000-00032

  3. 3.

    Jarvis WR: Benchmarking for prevention: the Centers of Disease Control and Prevention's National Nosocomial Infections Surveillance (NNIS) system experience. Infection 2003, (Suppl 2):44-48.

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Bleakley, S., Lavery, G., Trainor, D. et al. Does improved oral hygiene alone prevent ventilator-associated pneumonia?. Crit Care 13, P292 (2009). https://doi.org/10.1186/cc7456

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Keywords

  • Oral Hygiene
  • Chlorhexidine
  • Dental Plaque
  • Concurrent Control
  • Intervention Zone